Coeliac disease

Gluten intolerance (also known as coeliac disease) is an autoimmune reaction to gluten, a constituent of various cereal grains.

In Switzerland roughly one per cent of the population suffers from coeliac disease. In people with coeliac disease, gluten (binder protein in different types of grains) causes damage to the mucosal lining of the small intestine. A symptom-free life is usually possible if a gluten-free diet is followed.

Causes, triggers

People with coeliac disease have a genetic predisposition. As a result, consumption of gluten results in damage to the mucosa of the small intestine. Gluten is a collective term for binder proteins found in different types of grain (wheat, spelt, rye, barley, oats, emmer, unripe spelt, kamut, einkorn and triticale). The damage leads to the breakdown of villi lining the small intestine, thereby reducing the surface area of the intestine. This means that nutrients (carbohydrates, fats, proteins, vitamins and minerals) may be absorbed less effectively and sufficient quantities of these nutrients are no longer available to the body. During the course of the disease, these nutrient deficits can cause deficiency symptoms (e.g. iron deficiency) and relevant consequences (e.g. anaemia).

Symptoms

The symptoms of coeliac disease are characterised by their diversity and varying degree of severity. There are also some forms of coeliac disease in which few, if any, noticeable symptoms occur.

Diagnosis

If coeliac disease is suspected, the specific coeliac antibodies are measured in the blood (anti-tissue transglutaminase IgA and IgG, anti-endomysial IgA and IgG and anti-gliadin IgA and anti-gliadin IgG). Another diagnostic test is usually an endoscopy of the small intestine during which a tissue sample is taken (biopsy).

The level of coeliac-specific antibodies in the blood is diet-dependent and decreases if a gluten-free diet is maintained. This is why it is important not to start a gluten-free diet until the diagnosis has been confirmed. Otherwise, it would be difficult or impossible to establish the diagnosis.

Gluten-free oats (uncontaminated with wheat, rye, barley or spelt) are permissible in small quantities for most sufferers. The attending GP or gastrointestinal specialist can provide information on this point.

The following are gluten-free: sources of carbohydrate that are naturally gluten-free, such as potatoes, maize, rice, buckwheat, quinoa, amaranth, millet, teff flour and pulses. Unprocessed foods such as meat, fish, eggs, milk and dairy products, vegetables, fruit, vegetable oils and sugar are also suitable.

In the case of ready foods it is important to read the declaration to find out whether or not a product is suitable for coeliac sufferers.

A wide range of gluten-free specialist foods are available on the market. Sufferers can be guided by the Swiss Allergy Label (recommended by aha!) and the gluten-free symbol (crossed-out wheat ear).